Orthodontic facemasks are extraoral orthodontic appliances that influence maxillary and mandibular development in children with skeletal Class III malocclusion. While a facemask is most effective in patients before the growth spurt, skin irritation is common during the treatment. Therefore, this retrospective study aimed to investigate the prevalence and pattern of such skin changes and identify their possible associated risk factors. We included 177 patients with skeletal Class III malocclusion who underwent facemask therapy. Patient age and sex, orthodontic parameters expressing the severity of malocclusion, the presence of complaints in the temporomandibular joint (TMJ) areas, and the level of patient cooperation were evaluated. Additionally, the severity and onset time of skin reactions were further analyzed. The results indicated that 43.5% of patients developed skin changes typical of irritant contact dermatitis. Skin irritation was significantly associated with the presence of TMJ complaints and female sex. Furthermore, skin irritation was more common in younger patients. Clinicians should pay special attention to the skin areas that come into contact with the appliance during each follow-up visit to detect potential problems. Moreover, patients and their parents should be given adequate information about the possibility, prevention, and management of skin problems during facemask therapy.

ZusammenfassungAkne ist eine häufige Erkrankung mit hoher Prävalenz unter Jugendlichen („Pubertätsakne“). Jedoch gibt es weitere Sonderformen, die vor allem im Säuglings- und Kindesalter auftreten. Hierzu gehören Acne neonatorum, Acne juvenilis sowie Akne der mittleren Kindheit. Die Krankheit wird von endogenen (genetische Disposition, Androgene, Wachstumshormone) und exogenen (Propionibacterium acnes, Ernährungsgewohnheiten, mechanische Irritation) Faktoren moduliert. Pathogenetische Hauptfaktoren sind gesteigerte Talgproduktion, follikuläre Differenzierungsstörungen und perifollikuläre Entzündungsvorgänge. Für die Therapie stehen wirksame topische und systemische Medikamente zur Verfügung. Je nach Lebensalter des Betroffenen, werden unterschiedliche Behandlungsverfahren und Vorgehensweisen empfohlen.

Summary Ongoing high consumption of resources results in exceeding the planetary boundaries. Modern healthcare systems contribute to this problem. To address this issue, this article provides an overview of various aspects of sustainable actions in medical offices and clinics that can also be applied to dermatology. Specific fields of action include energy consumption, structural measures, traffic and mobility, organization including digitalization as well as personnel and evaluation. Moreover, we discuss specific topics such as hygiene and cleansing, dermatosurgery and prescription practices. External treatments and cosmetics are discussed separately as dermatological peculiarities. Finally, we provide information on established initiatives for more sustainable health care in Germany. We aim to encourage critical reappraisal of currently established practices and to stimulate the implementation of sustainable measures.

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Orthodontic facemask is an extraoral orthodontic appliance used in children with skeletal Class III malocclusion to influence the maxillary and mandibular developments in a favorable direction. While the use of facemask is the most effective in patients before the growth peak, skin irritation is often observed during the treatment. Thus, the present retrospective study aimed to investigate the prevalence and pattern of such skin changes and distinguish the possible factors associated with them. Patient age and sex; orthodontic parameters, expressing the severity of malocclusion; the presence of complaints in the temporomandibular joint (TMJ) areas; and the level of patient cooperation were evaluated. Additionally, in patients with skin reactions the severity and onset time were further analyzed. The results indicated that 43.5% of the patients experienced skin changes, which were characteristic for irritant contact dermatitis. The presence of TMJ complaints, and female sex were found to have a statistically significant correlation with the occurrence of skin irritation. Furthermore, skin irritation was observed more frequently in younger patients. Clinicians should give a particular attention to the skin areas, which come in contact with the appliance at every visit in order to detect any potential problems. Moreover, patients and parents should be provided with sufficient information, regarding the possibility, prevention and management of skin problems during facemask therapy.